Presume India to be in stage 3 and let’s practice lockdown with a 100% compliance: Dr Arvind Kumar

The total number of Covid-19 infected cases on Monday crossed 7 lakh globally even as the world upped the ante in its fight against the virus. In India, the number stood at about 1200 as of March 30 as the government imposed clampdown to contain the spread through a 21-day lockdown which began at midnight on March 25.

ETCFO spoke with Dr Arvind Kumar, chairperson, Centre for Chest Surgery at Sir Ganga Ram Hospital, New Delhi to understand the Covid-19 situation in depth and the road ahead for the country. Edited excerpts.

Q: How would you view lockdown as a measure for containing virus spread?

Arvind Kumar: It is a bold and historic move taken by the Prime Minister, which needs to be fully complied to prevent a chaotic situation in the country. One must remember Covid-19 is different from other viruses for it has a very infectivity.

Countries worldwide did not place lockdown earlier enough and let virus spread. It happened in China, followed by Italy, France, Spain, UK and now the US. They did not take radical steps like imposing lockdown at a time when virus was introduced in the community. Today, they have a large number of infected people, needing healthcare facilities.

Country like Italy, which has a population of about six crore, has so far reported more than 6,000 deaths. There, the number of patients are more than the number of ventilators itself. Doctors are having to make tough decisions in terms of who to give ventilators to. This is a catastrophic situation for any country where its health care facilities get inundated with such a large number of infected patients. Juxtapose that figure to India, and the count will be like 130,000, which is huge.

In that backdrop, lockdown, therefore, is a crucial measure to cease the virus spread. Its effectiveness of course depends on what stage the development cycle of an epidemic is. That is if used in the initial phase where the total infected volume is low, it can limit the number of cases presented to healthcare facilities, as India has done.

Q: What if the lockdown is not complied properly?

Arvind Kumar: Once the government has taken the bold step, it is its duty to ensure clampdown is abided by. Whether this is through persuasion, communication or police, it has to be complied with.

If lockdown is proving ineffective, then I would suggest hand over the whole country to the army. One must remember that we cannot afford to have a few lakh people in this country risking the life of entire 130 crore population. Telangana CM indicated last week if nothing else works, he will give shoot at sight orders to make sure people abide by lockdown, I completely agree.

At the same time, the government also needs to also ensure the minimum food supplies are in place, and that the sewage disposal and sanitation systems are running. The PDS operations can be taken care of by the police where they can supply food at the doorsteps.

Also, equally important will be to take care of our healthcare soldiers and police so that they continue to function at their optimum levels, and not tire themselves up. It is extremely vital for them to over last these 21 days without exhaustion.

Q: But we have already seen issues in implementing lockdown with thousands of migrant workers stuck at states’ borders, wanting to return back to their villages….

Arvind Kumar: It all depends on how you present it to people. After all, the lockdown is imposed for whose benefits. The virus does not differentiate between the rich or the poor.

Q: Can lockdown or social distancing actually work in say clusters like Dharavi?

Arvind Kumar: In slums, social distancing may not be practised as rigidly and effectively as it can be elsewhere. But even then, people living in jhuggis, can be told to remain inside their homes, and may be discouraged to mingle within their communities. Essential services can be provided to them at their doorsteps by police. Imagine if 1 per cent gets affected with virus, the whole slum can be wiped out. It is, therefore, important that social distancing be applied in whatever best possible manner in slums as well.

Q: There is a view that India has not done enough testing, and there could be a case where people infected could be larger than what the number actually is. What do you think?

Arvind Kumar: There has been much controversy about testing. If I were to place things in order of priority, I would say 90 per cent efforts or resourced need to be deployed for social distancing or isolation, and the rest 10 per cent towards testing. Testing alone would not help prevent the contagion, but isolation certainly will.

Only way of preventing catastrophe is social distancing practiced with 100 per cent compliance. There is no confusion among public health experts.

Arvind Kumar: I would presume our country already to be in stage 3. There is no harm in over-reaction. This is precisely the mistake committed by countries like Italy, Spain, and later the UK and the US. They just went by the available numbers, and thought they were in stage 2.

When an infected person spreads virus in the community, people there would typically take a few days to develop symptoms. In many instances, they may not develop symptoms at all, and may not undergo testing at all. Therefore, one does not need to have to wait for the disease to play around, since by then the ball would have already been out from your hands.

So, if we presume India in stage 3, it is only at its beginning. Lockdown therefore if complied properly will contain the virus spread. At the same time, testing should go hand in hand, for it will help us find hotspots, which can then individually be dealt with. As of today, going by the early trends, Kerala and Maharashtra are emerging as two hotspots.

Q: What are the key challenges facing Doctors?

Arvind Kumar: Challenges facing doctors are three-fold. First, they carry greater risk of infection as they deal directly with patients who are affected with Covid-19. They require personal medical equipment to protect themselves.

Second challenge is related to exhaustion, which can come in doctors and paramedics if they are not handled properly. Therefore, there is a need for a roaster system to take care of this aspect.

Another challenge the medical fraternity faces is of being socially boycotted, where sadly the people who are risking their lives for the ones, those very people are ostracizing them. It is very easy for doctors to say they are also going on social distancing mode. It is high time the society rose to the occasion.

Q: How do you see the situation emerging going forward?

Arvind Kumar: If India practices lockdown with 100 per cent compliance, definitely an Italy like situation can be avoided.

The biggest need of the hour is to prevent the infected volumes from increasing. If the lockdown is not complied properly, we may actually end up in a situation worse than Italy.

The PM in his speech while announcing lockdown made it very clear these 21 days would decide if India will remain where it is, or it will go back 21 years back.

Simply put, lockdown will actually decide whether India creates history or become a part of history.

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